Diabetic ketoacidosis

Definition

Diabetic ketoacidosis is a problem that occurs in people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.

Byproducts of fat breakdown, called ketones, build up in the body.

Alternative Names

DKA; Ketoacidosis

Causes

People with type 1 diabetes do not have enough insulin, a hormone the body uses to break down sugar (glucose) in the blood for energy. When glucose is not available, fat is broken down instead.

As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.

Blood glucose levels rise (usually higher than 300 mg/dL) because the liver makes glucose to try to combat the problem. However, the cells cannot pull in that glucose without insulin.

Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.

People with type 2 diabetes can also develop ketoacidosis, but it is rare. It is usually triggered by a severe illness. Hispanic and African-American people are more likely to have ketoacidosis as a complication of type 2 diabetes.

Exams and Tests

Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample. Blood ketone testing is also now available, but it is more expensive than urine testing.

The cause of the condition (such as infection) will be found and treated

You may be able to spot the early warning signs and make changes at home before the condition gets worse. It is important to stay in close touch with your doctor.

Outlook (Prognosis)

Acidosis can lead to severe illness or death. Improved therapy for young people with diabetes has decreased the death rate from this condition. However, it remains a big risk in the elderly, and in people who fall into a coma when treatment has been delayed.

Possible Complications

When to Contact a Medical Professional

This condition can become a medical emergency. Call your health care provider if you notice early symptoms of diabetic ketoacidosis.

Go to the emergency room or call the local emergency number (such as 911) if you have:

Decreased consciousness

Fruity breath

Nausea

Trouble breathing

Vomiting

Prevention

People with diabetes should learn to recognize the early warning signs and symptoms of ketoacidosis. In people with infections or who are on insulin pump therapy, measuring urine or blood ketones can give more information than glucose measurements alone.

Insulin pump users need to check often to see that insulin is still flowing through the tubing, and that there are no blockages, kinks, or disconnections.